Vessel Occlusion As A Method Of Treating Aneurysms

Vessel occlusion is a viable treatment technique for several types of aneurysms, including those that are difficult to access surgically, wide-necked, or large. An evaluation of the stability of intracranial berry aneurysmal occlusion with detachable coils found only a 14% recurrence rate of completely occluded aneurysms and a 0% rate of rebleeding (54). In a study in which 3 patients with peripheral cerebellar artery aneurysms were treated by parent-vessel occlusion, good or excellent clinical recovery was achieved by all patients, and parent-vessel occlusion was demonstrated to be feasible, safe, and effective (55). It has been suggested that parent-vessel occlusion be considered the first option for treatment of VA-dissecting pseudoaneurysms in patients who will tolerate sacrifice of the parent vessel along its diseased segment (56). Permanent occlusion of the VA for vertebrobasilar fusiform and dissecting aneurysms has also been proven as a useful therapeutic endovascular technique with good long-term outcomes (57). For large cavernous sinus aneurysms, proximal occlusion of the internal carotid artery (ICA) is the treatment of choice. Long-term follow-up of patients treated by proximal occlusion of the carotid artery by Silverstone clamping revealed neurologic improvement and no aneurysm rupture in 8 of 11 patients, although several complications were reported (58). The authors of the study suggested that therapeutic carotid artery occlusion be preceded by strict test ICA occlusion. Currently, Food and Drug Administration (FDA)-approved detachable silicon balloons are not available in the United States, a situation that is hampering clinical care.

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